Chronic or episodic forms of tension-type headache (TTH) affect a high percentage of the population and not only impact personal life, but also pose a significant socio-economic burden in terms of lost workdays and decreased worker productivity. Although TTH is the most prevalent of the headache disorders, research into specific treatments is inadequate and lags all other major headache classifications. The International Headache Society indicates that a muscular involvement is associated with some forms of tension-type headache. A muscular involvement is confirmed in the research literature, as elevation in muscle tenderness, myofascial trigger point's (MTrP's), and physical abnormalities in cervical and cranial muscles are often reported by patients with TTH. Thus, a treatment approach that addresses the skeletal musculature may be an important component in the management of TTH. Complementary and alternative medicine approaches, such as massage, to the treatment of tension-type headache are increasingly popular among patients, but evidence supporting their efficacy is limited. Muscle tissues of patients with TTH have noteworthy differences from a healthy control population, which provide a theoretical basis for manual therapy as a treatment for TTH. For example, a MTrP within a muscle can elicit pain locally (point tenderness) and at distant sites (referred pain) that mimic the patient headache pain complaint, which makes it a site of particular interest by both the headache patient and massage therapist. We recently reported, in a case series, that massage therapy with a focus on MTrP therapy significantly reduced frequency and duration of headache in those with tension-type headache. However, the potential for massage to be used as a clinical resource is limited by verification of its effectiveness in a controlled clinical trial. The intent in this proposal is to assess the effectiveness of therapeutic massage for tension-type headache in a placebo-controlled, randomized clinical trial. Specifically, the objective of this proposal is to determine the impact of a structured massage therapy program, with a focus on myofascial trigger point therapy, on pain and disability measures in participants with TTH. Sixty subjects with TTH will be randomized into massage therapy, placebo or wait-list control groups. Trained therapists will follow a defined protocol to administer 12 massage therapy sessions or 12 sham treatments over a six-week period. Subjects will record headache parameters in a daily diary and complete evaluations to assess disability due to TTH. Thus, Specific Aim #1 is to confirm and extend our recent findings that massage therapy will reduce the frequency, intensity and duration of headache in patients with TTH in a randomized, placebo-controlled trial. Since TTH can also affect the quality of daily living, Specific Aim #2 is to determine the effect of massage therapy on disability associated with headache in patients with TTH. PUBLIC HEALTH RELEVANCE: Tension-type headache is a painful condition that can affect ones quality of life and productivity for many years, but has few treatment options. Verification of massage therapy for the treatment of tension-type headache in a randomized, controlled trial design will create new treatment options for patients with this condition.